FLINDERS MEDICAL CENTRE

POLICY



COUNTING OF SPONGES, SWABS, INSTRUMENTS & NEEDLES



Endorsed by the Operating Theatre Service Management Committee	



Date:	Signed:



Review Date:



Implementation Date:

	______________________________________________________



POLICY STATEMENT

All accountable items used during an operative procedure must comply with the appropriate standards as 

defined in the ACORN Standards.



All accountable items added during the procedure are counted and recorded on the count sheet.  A second 

count is performed at the commencement of the closure of any cavity, or wound.



A registered nurse is designated in charge for each operative procedure.



Every count must be performed by two nurses, one of whom is a registered nurse.



The same two nurses should be responsible for all counts and additions during a procedure whenever 

practicable.  Should it become necessary to replace the instrument nurse during a procedure, a complete 

count, including tray lists, will be conducted, recorded and signed by the incoming and outgoing nurses.  

Should it become necessary to replace the circulating nurse during a procedure, a count of the accountable 

items on the count sheet, not including tray lists, will be conducted, recorded and signed by the incoming 

and outgoing nurses.



The nurses responsible for the count view the items together and count aloud.  Each accountable item is 

separated during the count procedure.  A check is made, by both nurses, for item integrity, loose fibres, and 

foreign matter and each raytec strip must be visible.  All sponges, and swabs are counted into separate 

groups of five.  They are not added to already counted sponges and swabs until the correct number in the 

packet is verified.  If there is an incorrect number in the packet, the entire packet and contents are placed in 

a sealed plastic bag, marked appropriately and removed from the theatre.  If any interruptions occur during 

the counting procedure the count is recommenced.



Counting away sponges and swabs is recommended.  All items are opened out fully and counted into a 

clear plastic bag in groups of five sponges and ten swabs, with the number contained written on the outside 

of the bag.  These counted away items remain part of the count.  If any count discrepancies occur the bags 

are opened and their contents recounted.



No counted items, rubbish or linen may leave the theatre until the completion of the procedure and all 

counts have been performed.  Items remaining by intention in the patient are recorded on the count sheet.  

Should it become necessary for instrument/s to be removed from the theatre, the permission of the 

registered nurse designated in charge of the procedure must be obtained.  When removed the item/s must be 

recorded on the tray list and count sheet as well, if applicable.



A final count is performed at the commencement of skin closure.  The surgeon is notified of the outcome of 

each count and verbally acknowledges that they have heard the outcome.  Any discrepancies in the count 

are reported immediately to the surgeon and the registered nurse in charge of theatre suite.  A thorough 

search is made for the item. If not found the surgeon may order an x-ray to confirm whether article is inside 

patient.  The discrepancy and any subsequent action is reported and recorded.



The count sheet is signed by both nurses responsible for the count. 



Should two or more procedures be carried out sequentially on the same patient and the operating room 

cleared between procedures, with different “set-ups” being used, a separate count sheet is used for each 

procedure.

Should two or more procedures be carried out sequentially on the same patient and the operating room is 

not cleared between procedures, with the same “set-ups” being used, it is necessary to use a separate count 

sheet for each procedure. The final count of the first procedure may be carried over to be the first count of 

the second, or any subsequent procedure.



Do not cut or divide any counted item.  If divided by a surgeon, e.g., cotton tape, every cut section must be 

added to the count sheet, or accounted for, then tied, or clipped together.



If no accountable items are used in a procedure and no count is done, “NO COUNT DONE” is written on 

the count sheet which is signed and retained.



RATIONALE:

It is essential for the safety of the patient and for the legal protection of the nursing staff.



REFERENCES:

ACORN Revised Standard A-19, A-20 & A-21

NSW Health Department, TS10 - Standard Procedures for the Handling of Accountable Items in the 

Operating Suite, 3rd Ed., (Reprinted) NSW Health, 1994.